Provider Demographics
NPI:1619907524
Name:MCEVOY, JOHN JOSEPH JR (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:MCEVOY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WALT WHITMAN TRL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-2729
Mailing Address - Country:US
Mailing Address - Phone:973-971-0197
Mailing Address - Fax:973-340-2473
Practice Address - Street 1:152 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-340-8970
Practice Address - Fax:973-340-8632
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02487213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7793308Medicaid
NJ7793308Medicaid
NJ5465040001Medicare NSC
017388Medicare ID - Type Unspecified